title: Primary care practice and health professional determinants of immunisation coverage.
abstract: OBJECTIVE
  To identify primary care factors associated with immunisation coverage.
  
  
  METHODS
  A survey during 2005-2006 of a random sample of New Zealand primary care practices, with over-sampling of practices serving indigenous children. An immunisation audit was conducted for children registered at each practice. Practice characteristics and the knowledge and attitudes of doctors, nurses and caregivers were measured. Practice immunisation coverage was defined as the percentage of registered children from 6 weeks to 23 months old at each practice who were fully immunised for age. Associations of practice, doctor, nurse and caregiver factors with practice immunisation coverage were determined using multiple regression analyses.
  
  
  RESULTS
  One hundred and twenty-four (61%) of 205 eligible practices were recruited. A median (25th-75th centile) of 71% (57-77%) of registered children at each practice was fully immunised. In multivariate analyses, immunisation coverage was higher at practices with no staff shortages (median practice coverage 76% vs 67%, P = 0.004) and where doctors were confident in their immunisation knowledge (72% vs 67%, P= 0.005). Coverage was lower if the children's parents had received information antenatally, which discouraged immunisation (67% vs 73%, P = 0.008). Coverage decreased as socio-economic deprivation of the registered population increased (P < 0.001) and as the children's age (P = 0.001) and registration age (P = 0.02) increased. CONCLUSIONS Higher immunisation coverage is achieved by practices that establish an early relationship with the family and that are adequately resourced with stable and confident staff. Immunisation promotion should begin antenatally.
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand. cc.grant@auckland.ac.nz
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Grant
authors.forename: Helen
authors.initials: H
authors.lastname: Petousis-Harris
authors.forename: Nikki
authors.initials: N
authors.lastname: Turner
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.forename: Rhys
authors.initials: R
authors.lastname: Jones
authors.forename: Deon
authors.initials: D
authors.lastname: York
authors.forename: Natalie
authors.initials: N
authors.lastname: Desmond
authors.forename: Joanna
authors.initials: J
authors.lastname: Stewart
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D003140:Communicable Disease Control / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D009520:New Zealand; D009726:Nurses / Q000523:psychology / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis